Robyn Urback

When the Canadian government passed legislation nearly a decade ago to approve medical assistance in dying (MAiD), it was an exercise in compassion. A competent Canadian adult suffering from an “irremediable medical condition,” whose death was “reasonably foreseeable,” would no longer have to suffer; MAiD would offer a way to avoid the unnecessary pain, the loss of dignity and the loss of autonomy that often comes with natural death. In narrow circumstances and with strict safeguards, MAiD could expedite a process that was already occurring.

Since then, MAiD has morphed from being a last resort to an option among many: a path for those suffering from chronic illnesses or disabilities, a suggestion for those experiencing suicidality, and even a choice offered to veterans seeking assistance from the federal government.

In 2019, Quebec’s Superior Court struck down the part of the law that limits MAID access to those whose death is “reasonably foreseeable,” and with that move it inadvertently changed the concept of state-assisted death as a matter not simply of personal autonomy in how one chooses to die, but a matter of how and if one chooses to die. Along with its failure to establish clear and stringent safeguards, and clear and stringent guidelines, Canada is seeing a worrying trend whereby the poor, the vulnerable and those with disabilities are disproportionally accessing MAID.

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A recent report released by Ontario’s chief coroner into MAiD deaths involving dementia patients offers stark examples. One case reviewed by the MAiD Death Review Committee (MDRC) is that of a woman in her late 80s with “cognitive impairment” whose “wish to die” was brought forward by a family member.

This woman, who is referred to as Mrs. 6F, experienced multiple falls and was admitted to hospital where she was diagnosed with “moderately advanced dementia.” It was during that admission that a family member told her care team about her desire to access MAiD, and though a referral was made and a discussion had with a MAiD practitioner, she opted to transition to long-term care at that time instead.

Approximately four months later, a family member again made a referral for MAiD on her behalf. A MAiD practitioner assessed her eligibility – with a family member present – and determined that Mrs. 6F “met the criteria for an incurable condition, citing advanced dementia, chronic comorbidities, and terminal frailty.” The practitioner only made “limited evaluation of Mrs. 6F’s cognitive impairments,” and facilitated a third-party signer, since Mrs. 6F attempted to sign the form but was unable. As is required, a secondary assessor evaluated the woman and approved MAiD for the following week.

On the day of the procedure, Mrs. 6F became “overwhelmed” by the number of visitors in her room and several were asked to leave. The report noted that “final express consent was determined based on Mrs. 6F’s ability to repeat the consent question and via squeezing the provider’s hand.”

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This is an edge case, obviously. We know that the vast majority of MAiD provisions in Canada are carried out for those whose death is “reasonably foreseeable” (95.9 per cent in 2023), with the majority suffering from cancer. But those trends are irrelevant if even one person is being effectively euthanized under laws created by the state. Did that happen to Mrs. 6F? We don’t know. But we do know that her MAiD referrals were made by a family member and that she was assessed with a family member present, which would lead reasonable people to wonder if pressure from family played a role.

It’s also reasonable to wonder about the extent to which Mrs. 6F had capacity to consent to a life-ending procedure; her ability to repeat the consent question could have been an expression of understanding, or simply a symptom of echolalia, which some dementia patients experience.

We don’t have answers, but the point is that when someone’s life is being ended for them, these lingering questions should not exist. According to the MDRC report, 103 MAiD deaths were reported between 2023 and 2024 where dementia was the primary condition. Among those cases was one where a man in his 80s with an Alzheimer’s diagnosis was evaluated by both MAiD assessors on a day when, according to the report, he was experiencing delirium. It’s impossible to say how many more MAiD provisions have been carried out on individuals experiencing some form of cognitive impairment.

It’s clear that Canada has lost the plot on MAiD. What started out as a compassionate option for those in advanced stages of dying has morphed into a state-sanctioned death apparatus for anyone – and/or their family members – who knows how to navigate the loose safeguards that are supposed to ensure that this life-ending procedure is carried out with the utmost caution. There is a word for ending someone’s life without their informed, lucid consent, and it’s not “compassion.”